=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841520715
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFREY G. PITTS, D.C., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2009
-----------------------------------------------------
Last Update Date | 12/28/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 NE 25TH AVE
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34470-6319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-732-0200
-----------------------------------------------------
Fax | 352-732-2623
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 NE 25TH AVE
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34470-6319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-732-0200
-----------------------------------------------------
Fax | 352-732-2623
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. JEFFREY G. PITTS
-----------------------------------------------------
Credential | D.C., P.A.
-----------------------------------------------------
Telephone | 352-732-0200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH0002867
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------